End celebrity endorsement of screening, say researchers
The
convict tradition runs deep down under. When a company promoting full
body computed tomography was looking for a celebrity to help sell its
wares, it turned to the star of that highly successful Aussie soap
opera Prisoner, Val Lehman. So on any given Sunday
morning this year, many Australians leisurely flicking through the
papers have found themselves face to face with the daunting image of
prison heavyweight character Bea Smith urging them to go out and get
screened for everything. Likewise, former Ashes winning Australian
cricket captain Alan Border has been brought in to bat for an
advertisement series on body
scans.
Sadly for Val and
Alan, the image of full body computed tomography has become a little
tarnished in Australia and elsewhere. Indeed, an Australian state
health authority was so concerned about the failure to properly
communicate risks and benefits in some of the promotion that it issued
a public health alert in 2004: "Full body scans . . . involve
doses of radiation that health experts do
not consider to be justifiable in terms of
a health check."
Until now we
have had no real idea what sort of impact celebrities like Val Lehman
and Alan Border have on those sleepy Sydneysiders reading their Sunday
papers. Now a snappy little study just published in the United States
gives us some hard data on the effects of celebrity selling, and some
cause for grave concern about the way stars are influencing their
adoring
public.
Researchers from
the prestigious Dartmouth Medical College, led by Robin Larson, have
produced one of the first rigorous investigations
of how celebrities affect enthusiasm to seek screening
services. The paper specifically looked at screening for
breast cancer and colon cancer, and PSA
(prostate specific antigen) testing for prostate cancer
(Journal of the National Cancer Institute
2005;97:693-5).
After
telephone interviews with 500 US households, the researchers found that
more than half of the respondents "had seen or heard a celebrity
talk about" each of the three screening programmes. Given the
representativeness of their sample, this suggests that half of the
entire adult population has seen celebrity endorsements for screening,
some of which are extremely aggressive in their language. Two examples
cited in the paper include former New York City mayor Rudy
Giuliani's statement about PSA testing for prostate
cancer, "Of course, we probably wouldn't be
talking about this if I hadn't gotten screened . . ." and
his following plea, "If you're over 50 or in a high risk
group, please get screened - now." US journalist Katie Couric
made a similarly powerful plea to undergo colonoscopy screening for
colon cancer: "Don't end up saying ‘if only.'
Get tested."
The obvious
problem with this simplistic emotional rhetoric is that it is
simplistic, emotional, and it is rhetoric - it is not rational or
scientific and it is designed to persuade rather than inform. As the
science of screening unfolds we learn more every week that the costs,
harms, and benefits of screening programmes to society and individuals
are complex and uncertain. As the Dartmouth researchers make clear,
there are many people who will benefit from these tests, but there are
others for whom the early detection of cancer will bring unnecessary
testing and treatment.
Getting
noticed by the public is getting harder because of a more global media
environment. Developments like the internet, mobile phones, and
multiple television channels have fragmented the marketplace.
Celebrities can break through this information overload, because they
are instantly recognised and have their own personal
"brand," that they lend to the product or service that they
are endorsing or selling, whether they are paid or
not.
In Britain, some
public health researchers were outraged last year to learn that the US
biotech company marketing a test for human papilloma virus, HPV, had
worked with a global public relations company to orchestrate a major
lobbying campaign involving celebrities including the one-time
girlfriend of Hugh Grant, Liz Hurley. According to a powerful
investigative report in the Observer, some of the stars did not
even know that they were endorsing a campaign, covertly organised by
the test maker and its PR
company.
One of the strongest
critics of that example of celebrity selling was Dr Angela Raffle, who
oversees screening programmes for more than one million people in and
around Bristol. She said that while there were scientific trials
underway to assess the value of the HPV test in the wider cervical
cancer screening programme, the celebrity selling was designed to
"bypass the science" and create an atmosphere where
politicians could accuse the scientists of "dragging their
feet" by insisting on rigorous, but slow, assessments of
potentially valuable new
technologies.
The problem according
to Raffle was that there was no strong evidence that the widespread use
of HPV testing will "make any measurable difference to the deaths
prevented." She suggested that there was evidence that widespread
use of the test could actually increase the anxiety and uncertainty for
women, which is already an issue with the current programme. In the
interest of fairness and self-flagellation, it's important
to add another of her comments. "Even the BMJ fell for the
celebrity campaign," she says, citing an enthusiastic news story
from 2001, when the company backed celebrity campaign was already
underway.
SIPA/REX
Rudy Giuliani:
urged PSA testing
The problem is that celebrities don't tend to
make statements based on evidence, according to leading cancer expert
and Sydney University professor Bruce Armstrong. "Just because
Mayor Giuliani believes his life was saved by screening is of no
evidentiary value."
Professor
Armstrong says that alongside the benefits there are risks:
"While governments or other bodies may promote the benefits of
screening, not enough attempts are being made to present an accurate
picture of what the downsides
are."
Echoing Professor
Raffle's and Dr Armstrong's call for scepticism and action,
the Dartmouth researchers conclude their recent paper with a powerful
call for reform: "We see no obvious role for celebrity
endorsement of cancer
screening."
Ray Moynihan, visiting editor, BMJ
Email: raymond.moynihan@verizon.net
Liz Jakubowski, freelance writer, Australia
studentBMJ 2005;13:221-264 June ISSN 0966-6494
